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A new design for posterior inlay-retained fixed

partial denture

Article January 2013

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Abdulaziz Samran
Christian-Albrechts-Universitt zu Kiel, Germany. College of Dentistry, Ibb University, Yemen.
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JPOR-174; No. of Pages 3

Available online at www.sciencedirect.com

Journal of Prosthodontic Research xxx (2013) xxxxxx

www.elsevier.com/locate/jpor

Letter to the Editor

A new design for posterior inlay-retained fixed partial

denture

Dear Editor,

One of the basic principles of tooth preparation in fixed

prosthodontics is conservation of sound tooth structure in order to
preserve tooth vitality and reduce postoperative sensitivity.
Conservative preparation designs such as inlay-retained fixed
partial dentures (IRFPDs) are much less invasive than conven-
tional full-coverage crown preparations. Several investigations
introduced and examined different designs of conservative
FPDs with the aim of conserving tooth structure [1,2].
With the introduction of new adhesive materials, FPDs with
minimally retentive preparations attracted wide practice in
modern clinical dentistry. The adhesive material should not
only act as adhesive but also should support the remaining tooth
structure [3]. Partial veneer preparations provide less resistance
to displacement than complete veneer preparations, but partial
veneer preparations are more conservative and may offer a
number of advantages such as: preservation of tooth structure
and pulp vitality, the margins are easily accessible for a
practitioner to finish, and there is less potential for gingival
irritation. Furthermore, with partial coverage restorations there
is a possibility for testing pulp vitality via the remaining sound
tooth structure, and in most cases there will be no need for
temporary crowns or bridges.
IRFPDs are generally fabricated using metal-ceramic, all-
ceramic, and fiber-reinforced composite materials. These are
considered alternatives to posterior full coverage conventional
restorations [4,5]. All-ceramic and fiber-reinforced composite
IRFPDs are relatively costly restorations. Clinical evaluations
of three-unit metal IRFPDs showed debonding rate of about
30% after 6 years follow-up [6]. But the unsightly metal color
of the retainer, change in natural tooth translucency, and partial
debonding of retainers are common disadvantages.
The aim of this paper is to introduce a new design of
posterior IRFPDs which may enhance esthetic and resistance to
displacement.
The clinical and laboratory procedures involved are as
follows:
Step 1: Abutment selection and preparation:
Following patients assessment and thorough clinical
examination, prepare abutment teeth in a way similar to that
of preparation class II cavities. However, the following
points should be taken into account: a minimum of 2 mm
Fig. 1. The final shape of the IRFPD before cementation in the prepared
cavities.
depth for occlusal preparation should be kept, the bucco-
lingual width is approximately one third to one half the
distance between the tips of the buccal and lingual cusps, the
mesiodistal depth of the interproximal cavity should be at
least 1 mm, the preparation form should be unretentive in the
occlusal direction but, the divergence of the cavity walls
should not exceed 610 degrees (Fig. 1). Diamond burs can
be used for the preparation of the inlay cavities (Meisenger,
Hager & Meisinger GmbH, Duesseldorf, Germany). Atten-
tion should be paid to eliminate any sharp angles during
cavity preparation.
Step 2: Impression taking:
At this step, take the impression using either a two-stage
putty wash impression technique by additional silicone (Elite
HD, Zhermack SpA, Rovigo, Italy), or a one-stage impression
technique by polyether (Permadyne, 3M/ESPE AG, Seefeld,
Germany).
Step 3: Waxing up the FPD:
Pour the impression with extra hard stone (GC Fujirock
EP, GC Europe N.V., Leuven, Belgium) and wax up the FPD
with inlay casting wax (Renfert GmbH, Hilzingen, Germany)
in a way similar to that of waxing up inlays. However,
the retainers should not fill the occlusal cavities. Its thickness
should be approximately 0.5 mm leaving no less than
1.5 mm space in the occlusal cavity. Invest the wax patterns
with an investment material (Sherafina, Shera GmbH,
Lemfoerde, Germany) and cast them with noble or base

1883-1958/$ see front matter # 2012 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
http://dx.doi.org/10.1016/j.jpor.2012.09.005

Please cite this article in press as: Abdulkarim A. et al. A new design for posterior inlay-retained fixed partial denture. J Prosthodont Res (2013),
http://dx.doi.org/10.1016/j.jpor.2012.09.005
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JPOR-174; No. of Pages 3

2 Letter to the Editor / Journal of Prosthodontic Research xxx (2013) xxxxxx

Fig. 2. (A) Preoperative intraoral view illustrating loss of mandibular second premolars in a 24 years male patient. (B) Intraoral occlusal view illustrating the
abutment teeth prepared to receive the IRFPDs. (C) Try-in of the IRFPDs before cementation: (left) the new design and (right) the traditional design. (D) Intraoral
occlusal view of the IRFPDs after cementation: (left) the new design and (right) the traditional design.

metal alloys, e.g. a CoCr alloy (Wirbond C; Bego, Bremen, clear the space for the application of resin composite in the
Germany). second stage of cementation.
Step 4: Try-in of the metal framework: Stage 2: At this stage, condition all walls of the occlusal
Try in the metal framework and pay attention to the cavities using a self-etching bonding agent (Bond Force,
following points: Tokoyama Dental Corp., Tokyo, Japan) according to the
 The metal framework should properly and intimately fit to the manufacturers instructions. Afterwards, apply the posterior
prepared cavities. resin composite type (Estelite S, Tokoyama Dental Corp.,
 The metal framework should be stable in its place without any Tokyo, Japan) in the prepared cavities over the metal wings
noticeable movement. of the FPD. The procedure is similar to the filling of class II
 At least 1.5 mm space occlusal to each retainer should be cavities with light-cured resin composite by incremental
available in the occlusal cavity. technique.

Following this stage send back the framework to the dental
technician to complete its fabrication by adding porcelain to the
pontic framework. A modified ridge lap design of the pontic is
recommended.
Once the FPD is back from the laboratory, try it in again to
assure appropriate fit and occlusion. Fig. 1 shows the FPD
before cementation in the prepared cavities.
Step 5: Cementation of the FPD:
This should be carried out in two stages:
Stage 1: Cement the metal framework first.
Many types of cements can be used for this purpose.
However, the dual cure resin cements are highly recom-
mended. This is because these cements have the advantage of
both light and auto-polymerization resulting in stronger
retention and higher tensile bond strength [7,8]. After
sandblasting the bonding surfaces of the metal retainers with
50 mm aluminum oxide particles (Aluminum Oxide Abrasive;
Heraeus Kulzer GmbH, Germany), apply the resin cement
according to the manufacturers instructions. In order to
enhance the adhesion between the resin cement and the metal
surface of the retainers, it is recommended to use either the
electrolytic technique or the chemical etching (Met-Etch gel,
Gresco Products Inc., Stafford, TX, USA) of the casting to
produce surface micro-roughness [9,10]. Following cementa-
tion of the metal framework, remove the excess resin cement to
The metal framework of the suggested IRFPD should have
sufficient rigidity to resist occlusal and masticatory forces in the
posterior region of the mouth. To achieve this aim the thickness
of the metal wings should be at least 0.5 mm. Furthermore,
special attention should be paid to the design of adequately
thick and rigid connectors.
The thickness of the posterior resin composite layer should
be at least 1.5 mm; this is in order to achieve sufficient rigidity
to resist functional forces transmitted from the FPD to the
underlying metal wings of the framework. Furthermore, such
resin composite layer may enhance resistance to displacement
of the FPD retainers outward the prepared cavities.
The retention elements of the FPD are:
 The mechanical friction between the metal framework and
tooth walls in the prepared cavities.
 The resin cement used in the first step of FPD cementation.
 The adhesion between the resin composite placed over the
metal wings and the dental tissues.
The suggested IRFPD design is indicated for a single
posterior tooth replacement in bounded saddles areas. For
example, replacement of missing second premolar, first molar,
or second molar with the existence of a sound neighboring third
molar tooth. However, teeth with mobility grade II or more;

Please cite this article in press as: Abdulkarim A. et al. A new design for posterior inlay-retained fixed partial denture. J Prosthodont Res (2013),
http://dx.doi.org/10.1016/j.jpor.2012.09.005
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JPOR-174; No. of Pages 3

Letter to the Editor / Journal of Prosthodontic Research xxx (2013) xxxxxx 3

wide edentulous spaces and heavily restored abutment teeth can
be considered as contraindications.
With this suggested design the disadvantages of traditional
IRFPDs; previously mentioned, can be overcome. Esthetics can
be improved by the placement of resin composite over the FPD
wings which hide the metal color. Luting the bridge by resin
cement and placement of resin composite over the retainers
may reduce debonding rate and promote resistance to
displacement. However, this hypothesis needs to be substan-
tiated through laboratory and clinical research work. A possible
disadvantage of such design is the potential for gradual wear of
the resin composite layer placed over the wings of the FPD.
This may necessitates periodical follow-up visits to the dental
clinic to assure the integrity of the bridge structure. Fig. 2AD
illustrates a replacement of a mandibular left second premolar
using the suggested bridge design in a 24 years male patient.
The second premolar in the right side was replaced by a
traditional IRFPD. The patient was followed up for a one year
after bridge cementation with no recorded complications.
Clinical experience with such FPD design in Aleppo Faculty
of Dentistry appears to be promising. However, clinical trials
are required to examine the long-term durability of this IRFPD
and to compare its performance with other bridge designs. A
finite element analysis to study forces acting on such FPD is
suggested.
Acknowledgement
[6] Serdar Cotert H, Ozturk B. Posterior bridges retained by resin-bonded cast
metal inlay retainers: a report of 60 cases followed for 6 years. J Oral
Rehabil 1997;24:697704.
[7] Browning WD, Nelson SK, Cibirka R, Myers ML. Comparison of luting
cements for minimally retentive crown preparations. Quintessence Int
2002;33:95100.
[8] Fonseca RG, Dos Santos Cruz CA, Adabo GL, Vaz LG. Comparison of the
tensile bond strengths of cast metal crowns luted with resin cements. J Oral
Rehabil 2004;31:10804.
[9] Conceicao EN, de Goes MF, Consani S. Chemical etching solutions for
creating micromechanical retention in resin-bonded retainers. J Prosthet
Dent 1994;71:3039.
[10] Neto HG, Candido MS, Junior AL, Garcia PP. Analysis of depth of the
microporosity in a nickel-chromium system alloy effects of electrolytic,
chemical and sandblasting etching. J Oral Rehabil 2003;30:5568.
Amid Abdulkarim DDS, PhD
Department of Fixed Prosthodontics, Faculty of Dentistry,
University of Aleppo, Aleppo, Syria
Abdulaziz Samran DDS, MSca,b
a
Department of Fixed Prosthodontics, Faculty of Dentistry,
University of Ibb, Ibb, Yemen
b
Division of Prosthetic Dental Sciences,
Al-Farabi Dental College, Riyadh, Saudi Arabia
Marwan Aswad DDS, MSc
Department of Removable Prosthodontics, Faculty of Dentistry,
University of Aleppo, Aleppo, Syria

The authors thank Mr. Bashar Ris for technical support. Mohammad Zakaria Nassani DDS, PhDa,b,*
a
Department of Removable Prosthodontics,
References Faculty of Dentistry, University of Aleppo, Aleppo, Syria
b
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Corresponding author at: Department of Removable
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Please cite this article in press as: Abdulkarim A. et al. A new design for posterior inlay-retained fixed partial denture. J Prosthodont Res (2013),
http://dx.doi.org/10.1016/j.jpor.2012.09.005
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